Empyema with fistula successfully treated with a comprehensive approach including bronchial blocker and embolization receiving veno‐venous extracorporeal membrane oxygenation

We report the successful recovery of a patient with severe respiratory failure due to empyema with bronchopleural fistula treated with a comprehensive approach that included veno‐venous extracorporeal membrane oxygenation and a management strategy. The following management options should therefore be considered: (i) effective and safe initial drainage, (ii) extracorporeal membrane oxygenation for respiratory support for persistent respiratory failure with severe hypoxia, (iii) definitive treatment including endobronchial Watanabe spigot (EWS), which does not need to be completed (i.e., closing all fistulae) all at once, as reducing air leakage is the main goal for the first EWS (repeated EWS is required for complete bronchopleural fistula closure in patients with poor general condition such as in our case), (iv) general intensive care including nutrition and rehabilitation therapy as soon as possible.